Archive for May 2010

Years ago, in my first real, paying job in the mental health field, I gave an educational lecture to substance abuse clients about “nicotine.” Never have I been accepted in such a chilly and sullen manner.

The other therapists I worked with asked me how it went as this was the first time any lecture of this type had been given at that facility. I replied, “It’s a good thing I base my self-esteem on my weight, and not how well the clients like my lectures.”

I later learned that one of the clients who heckled me the most was a tobacco farmer from Kentucky. Okay, so I figured maybe it wasn’t me.

I then started a nicotine cessation program at that facility, an inpatient drug/alcohol/dual diagnosis rehab. The first hurdle was overcoming the staff resistance to addressing issues about tobacco smoking and chew.

The weekly client groups at first were voluntary, the clients assigned by their primary therapist. It was like pulling teeth to get a therapist to assign a client to the group. The belief was “one thing at a time,” meaning, don’t quit tobacco when you’re trying to quit drinking and/or drug use. It’s too much. Get this stuff handled, and then you can consider quitting smoking.

That is not my perspective, and research does not support this old-fashioned belief. The Big Book of AA suggests that newly sober members keep drinking their coffee, eating their candy bars, and smoking their cigarettes to help them stay sober, to not make any big changes that threaten their sobriety.

That was in the 1930s. We have the technology now to help folks get off these drugs. We have the research that demonstrates the importance of abstinence from these drugs in sobriety.

So why do we still hold to the old belief so solidly in the recovery field?

At least some of it is that some recovering professionals in the field still smoke. And many of those who are techs or otherwise not professionals but involved in the substance abuse recovery field still smoke.

Research I found many years ago indicated that over 75% of recovering addicts and alcoholics smoked or chewed tobacco, well over the national average, which was around 20% at that time. The leading cause of death of recovering addicts/alcoholics is tobacco-related.

What a crime…. individuals work so hard to get clean/sober, and then they just die from some other drug that no one encouraged them to stop using because they should take it “one thing at a time.”

It is true that not all mental health/recovery professionals hold to this old belief, but many do. Anyone of us who finds that belief unlivable, offensive, old fashioned and uninformed have a responsibility to continue to try to educate those who are poorly informed or resistant.

So the DSM has things like Major Depressive Disorder (see previous posts on “D” is for Depression), male erectile disorder (I have no experience in this area…) and so on. Nothing particularly interesting there.

How about “M” is for Mother? Fortunately or unfortunately, mothers do have a fair amount to do with mental health. I hear a lot from mothers who don’t want to be blamed for how screwed up their kids are. I hear a lot from kids (sometimes all grown up) who don’t want to blame their mothers for their troubles.

Sometimes it’s hard to tease out whose responsibility is whose, what’s what, or why. As an adult, can I still blame my parents (one, both or some other childhood caretaker) for my problems? I’m not about pointing the finger, but much like the oil spill in the Gulf of Mexico, if we understand what went wrong, maybe we can resolve it, clean up the mess, and move on.

I mentioned that I have a “bit” of ADD. I have compensated successfully all my life. It’s not something I struggle with a great deal, and on occasion I ask for help, but it’s no big deal. I have seen the big deal, however, in clients and friends, and I see how debilitating it can be.

For those of us with just a “touch” of an LD, the symptoms are easier to manage. My biggest struggles are in meetings (bored easily), keeping focused on one task at a time, and in knowing where to start when I have a massive pile (sometimes literally) of tasks.

In meetings, I get bored, pretty much all the time. I learned several years ago that if I get bored, I become a problem child. I fidget. I talk to others. I think disparaging thoughts about the person speaking. Eventually I find it intolerable and can’t wait for it to be over, even rushing out early if at all possible, breathing a sigh of relief. It’s true that some speakers or meetings are more interesting than others, but I experience this general pattern no matter what meeting I’m in.

In recent years, I discovered that multi-tasking during a meeting is a valuable compensation tool for me. I try not to be obvious about it, nor to multi-task in any way that might be offensive to others. I don’t text (okay, maybe a time or two…sorry…) and I don’t chew gum. I don’t talk to others around me. Instead, I doodle. I take notes if it interests me at all. I love to carry graph paper with me and draw designs on it.

Surprisingly, this help me focus on what is being said. This may not be surprising to those of you who have ADD. Focus is the issue, and multi-tasking can be helpful for some. It is for me. If I need to be listening to something, doodling is the way to go.

For some folks, doing something with their hands is the form of multi-tasking that works for them. I had one client who could braid friendship bracelets during an EMDR session and was able to process and focus much better than if she simply sat, holding the tappers. If she wasn’t multi-tasking, nothing happened in the session.

Obviously, some individuals have more severe forms of LD than this, but some of the same principles hold. Medication can be used to help, but it’s not the magic bullet that solves the problem. Plus, medication is prone to abuse (Ritalin and Adderall are basically Speed).

Behavioral compensation is essential for ADD or ADHD, in addition to medication therapy. Finding ways to cope and to manage the disorder is an imperfect but necessary part of living with LD.

Learning disabilities (LD) come in a great many flavors. I have a good friend who has a mathematics disorder. I have a bit of ADD. For individuals with more than one form of a learning disability, and perhaps more severe than the “bit” I have, the LD(s) can have a tremendous impact on one’s life.

My good friend with the mathematics disability has been impacted by more than just having trouble calculating a tip at a restaurant, although that was a problem for a long time. The mathematics issue is also a “spatial” issue, difficulty perceiving spatial relationships, seeing things in the mind’s eye as 3D, navigating space itself (clumsiness). For this woman, this undiagnosed LD led her through years of belief that she was stupid. Schools missed the problem. Parents missed the problem. Only when she decided to take classes as a 50-year old that required more math and spatial processing, and when someone finally said to her, “you should get tested for LD,” did she discover something she’s had all her life that has kept her from believing in herself – LD.

I observed this woman go through a painful grieving process, letting go of the hope of being able to study the subjects she was drawn to, but had not pursued until age 50. Her aspirations were gone in a moment, taken from hope about achieving her goals to absolute certainty that she could not.

Fortunately, she has the resilience to allow herself to grieve, and to continue to be curious about what she might be able to study and pursue as a new career field. While she does not yet know the answers, she is managing to stay in the question and navigate her feelings without despairing or collapsing.